Wider Group key comms March 2024

Welcome and introductions

The meeting was chaired by Andrew Stephenson, minister of state for health and social care.

Staff Survey 2023 results – Zoe Evans and John Drew, NHS England

In 2021, the NHS Staff Survey was redesigned to align questions to the seven elements of the NHS People Promise. The aim was to give the survey a structure that points towards making the NHS the best place to work. The survey is an official statistic that is run to the highest standard.

This year saw the largest number of responses to the survey, at 707,460 staff (48 per cent). John acknowledged the work organisations put into encouraging participation, including the use of paper surveys. Around 42,000 staff completed paper surveys. The survey included every Integrated Care Board (ICB), all bank staff, and a large proportion of primary care for the first time this year.

Staff experience and engagement has significantly improved this year, with every element of the People Promise seeing positive growth, including morale and engagement scores. Ambulance scores, which are generally lower than for other sectors, improved significantly. However, scores for medical staff have remained flat and for doctors and dentists in training have gone down, consistent with the industrial relations environment. The question of how to reconcile the improvements with anecdotal evidence was raised. What is clear is that overall, the Staff Survey demonstrates a significant improvement in staff experience this year based on a robust question set, a massive sample size and rigorous analysis.

Staff engagement and morale scores as key indicators of the current state of play with greater longitudinal data. Staff engagement scores are collected quarterly for all NHS trusts with roughly a 10 per cent sample size and correlate with quality of care, organisation performance, productivity; alongside reduced staff burnout, less agency spend, and a drop in sick absence. Quarterly scores leading up to the 2023 Staff Survey improved, and the 2023 Staff Survey score also saw improvement. However, staff engagement and morale are yet to return to pre-pandemic levels.

Other key takeaways:

• The leaver rate for all staff has now reduced to 7.7 per cent (Dec 2023), which is below pre-pandemic levels. The leaver rate at its peak was 9.4 per cent (Aug 2022), representing an additional 16,000 people remaining in the NHS.
• Diversity and inclusivity scores have remained relatively flat over the last three years. WRES and WDES data can provide additional insight into these. The prefer not to say group occasionally scores lower than all others, and the results for white staff are not always the highest compared to the scores for all other ethnic groups. More work is needed to understand how the data relates to protected characteristics.
• Data on the violence question is yet to be published due to a data collection error related to how the survey presented on a particular hand-held device. This is thought to have affected around 20,000 survey responses. NHSE is exploring ways to rectify this.
• The raising concerns theme saw little improvement; scores for appraisals have remained relatively low; medical and dental scores for recognition and reward have reduced.
• Improvements in scores for flexible working reflect the positive steps towards encouraging discussions on flexible working; the team theme saw improvements across the board.
• The NHS is not an outlier in terms of people considering leaving their current jobs in the next 12 months (Achievers Workforce Institute data).

A question on sexual safety was included for the first time, separate from the People Promise themes. The question was broad and covered everything from inappropriate conversations to assault. This gives the NHS a consistent baseline to understand and improve this issue, though more can be done around to collect data on sexual safety including locally. Ambulance sector scores were significantly higher than all other sectors.

Trade union reps were keen to identify the SPF’s key role in shaping the way forward and using the results and were interested in the inter-relationship between the staff survey and the WRES and WDES and the impact on the ground. They said it is critical how local organisations used this information for example the experience of staff with protected characteristics. Unions emphasised the importance of safe staffing levels. Unions also reflected on the importance of having paper surveys and how a large proportion of NHS staff are digitally excluded.

John highlighted the importance of recognising the people who have helped to improve their organisations scores.

Major Conditions Strategy – Jennifer Benjamin, DHSC

The Major Conditions Strategy (MCS) aims to identify what would make the most difference in tackling the six major conditions groups that account for around 60 per cent of ill-health and early death in England. The MCS is not a series of condition-specific strategies. The SPF engaged with Cathy Morgan, Office for Health Improvement and Disparities on the MCS in May 2023. The team has since identified key themes and headlines. 

On workforce, the MCS will speak to the importance of broadening training across the wider health workforce, and a move toward equipping all healthcare professionals with the skills required to deliver person-centred care. The team will continue working with stakeholders on areas such as addressing diagnostic workforce shortages, workforce training, condition management and having more generalists across the workforce. The MSC was developed in partnership to ensure its ambitions align with those in the NHS Long Term Workforce Plan. 

DHSC aims to publish the strategy in Summer 2024. There will be no additional funding.

Employers commented on generalism and balancing this with complex population needs, and new ways of working and communicating in the context of multidisciplinary teams. Employers appreciated the emphasis on investing in technology to support staff working with patients. Unions similarly commented on ensuring technology is in place to enable staff to fulfil their roles.

Unions said they would appreciate more information on how care coordination roles will be developed and who will fill them. They also highlighted the importance of looking at non-clinical support for multidisciplinary teams. Unions also discussed enabling staff to move between employing organisations outside of the NHS, carrying their full length of service with them and enabling them to upskill.

Isle of Wight NHS Trust 2023 HPMA partnership award winner

Isle of Wight (IOW) Trust won the 2023 HPMA award for partnership working. Amy Rolf and Sam Osbon, IOW; Jay Chappell, UNISON presented their winning case study, which included embedding a culture of ‘yes by default’ for flexible working. This was met with praise from the group. IOW joined the NHSE Flex for the Future programme supported by Timewise. They offered the following advice to other organisations developing their flexible working offers.

• Don’t be afraid to invite people sceptical about flexible working onto steering groups.
• Remember the patient is at the heart of everything.
• Give managers space to think differently.
• Small steps are small wins.

IOW is currently going through two major transitional changes:

• Community and mental health services are being transferred to a new organisation, merging with Solent NHS Trust and Southern Health Foundation Trust. Work is ongoing in partnership with union and HR reps across the organisations to ensure a smooth transition, including policy harmonisation.
• They hope to replicate the above with their acute and ambulance services as they work in a group model with Portsmouth Hospital University NHS Trust working to create a single corporate service across both trusts.